Gynae Flashcards
Risk factors for thrush
Diabetes
Recent antibiotics
Pregnancy
Immunosupression
Management of thrush
Oral fluconazole 150mg
Clotrimazole pessary
If pregnant - just pessary
Adenomyosis
Presence of endometrial tissue in the myometrium
Presentation:
- Dysmenorrhoea
- Menorrhagia
- Enlarged uterus
Investigations:
- MRI pelvis
- Transvaginal US
Management:
- Symptomatic treatment e.g. tranexamic acid to manage menorrhagia, mefenamic acid for pain
- GnRH agonists
- Uterine artery embolisation
- Hysterectomy
Fibroids
Presentation:
- Menorrhagia
- Abdo pain
- Bloating
- Urinary symptoms
Investigations:
- Transvaginal US
Management:
- Symptomatic treatment
tranexamic acid to manage menorrhagia, mefenamic acid - pain - IUS
- Combined pill
- Progesterone pill
- GnRH agonists - short term to reduce size
- Myomectomy if larger than 3cm
- Hysterectomy
Presentation of ectopic
Lower abdo pain
Shoulder tip pain
Bleeding
Dizziness
Risk factors for ectopic
IUD
PID
Endometriosis
Tubal surgery
IVF pregnancy
Progesterone only pill
Previous ectopic
Most common site of ectopic
Tubal - ampulla
Site of ectopic with most risk of rupture
Isthmus of tube
Investigation and management of ectopic
Investigation:
- bHCG test
- Transvaginal US
Management:
- If small (<35mm) and asymptomatic, with HCG of less than 1000 - watch and wait
- If small, no sig pain, HCG of less than 1500 - methotrexate
- If large (>35mm ) or pain, or detectable foetal heart, or HCG more than 5000 - salpingectomy/salpingotomy + methotrexate (plus anti D if relevant)
Types of miscarriage
Cervical os closed:
- Threatened - painless bleeding before 24wks
- Missed - some bleeding, dead foetus remains in utero
Cervical os open:
- Inevitable - heavy bleeding, POC not yet passed
- Incomplete - pain and bleeding, not all POC expelled
Management of miscarriage
- Expectant
- Medical - Misoprostol (+ antiemetics and pain relief)
- Surgical - misoprostol (to soften) plus vacuum aspiration under LA or GA
Management of PMS
1 - diet and exercise
2 - Combined pill
3 - SSRIs (continuous or phasic)
Management of stress incontinence
1 - pelvic floor training
2 - Duloxetine ‘locks it in’
Management of urge incontinence
1 - bladder retraining for 6 weeks
2 - Oxybutinin or solifenacin for elderly (less risk of falls)
Endometrial cancer
Presentation:
- Post menopausal bleeding
Investigations:
- Transvaginal US (<4mm)
- Hysteroscopy and biopsy
Management:
- Total abdominal hysterectomy and bilateral salpingooopherectomy
- Progesterone if elderly and can’t have surgery
Risk factors for endometrial cancer
Obesity
Nulliparity (progesterone during pregnancy is protective)
Early menarche
Unopposed oestrogen
Diabetes
Tamoxifen
PCOS
Hereditary non-polyposis colorectal carcinoma
Cervical smear screening
Tests for strains of HPV that are high risk for causing cancers
- If +ve HPV, send for cytology. If normal repeat in 1 year. If normal return to normal cycle. If not, repeat again in 1 year. If positive for a 3rd time - colposcopy.
- If +ve HPV and abnormal cytology. Send for colposcopy.
- If 2 inadequate samples - colposcopy.
Medical management of termination of pregancy
1 - mifepristone - orally
2 - 48hrs later misoprostol vaginally
PCOS
Presentation:
- Subfertility
- Oligomenorrhoae/amenorrhoea
- Hirsutism
- Acne
- Obesity
- Ancathosis ingrains
Investigations:
- Pelvic US - cysts
- LH:FSH inc, TSH, prolactin, testosterone, SHBG
- Exclude other conditions
Management:
- Weight
- COC pill
- Clomifene (anti-oestrogen) to help ovulate
Ovarian hyperstiulation
Range of presentation from mild to life threatening
- Fluid shift - oedema
- Nausea, vomiting
- Ascites
- Dyspnoea
Management:
- Fluids + electrolytes
- Anti- coat
- Abdo paracentesis if relevant
- Pregnancy termination
Most common type of ovarian tumours
Epithelial ovarian tumours - serous carcinomas
Spread of ovarian cancer
Local invasion
Lymph
Para-aortic lymph
Risk factors for ovarian cancer
Older age
Smoking
Increased number of ovulations - early menarche, late menopause
HRT
Obesity
BRCA
Protective factors for ovarian cancer
Reduced number of ovulations - parity, breastfeeding, COCP, early menopause
